Phase I: Acute
Goals:
- Alleviate acute pain and swelling
- Increase ROM 0-90° (emphasize 0° extension)
- Increase hamstring and quadriceps strength
- Promote comfortable ambulation WBAT with brace and crutches
- Maintain cardiovascular conditioning
Plan: (0-2 weeks)
- Patellar mobilization
- PROM positioning for knee extension
- ROM
- Heel/wall slides w/o brace
- ½ revolution non-resisted bike for knee flexion – progress to full revolution when patient reaches 110°.
- Hamstring and quadriceps co-contraction
- Hamstring and calf stretching
- 4-Quad (hip flexion, abduction, adduction, extension)
- Modalities for pain and edema control
Plan: (2-6 weeks)
- Soft tissue/scar mobilization
- Prone/standing knee flexion
- Proprioceptive training/ balance — BAPS, trampoline
- Weight shifting in standing, 0-30° ROM mini squats
- EMS co-contraction at VMO and hamstrings’
- Theraband ankle exercises – progress to standing as WB dictates
- Begin Stairmaster at 4 weeks
- General conditioning
- Aquatic therapy (when incisions healed) No whip kick
Phase II (6-12 weeks)
Goals:
- Decrease swelling and prevent atrophy
- Increase ROM -125°
- Increase quadriceps and hamstring strength
- Increase hip strength
- Stimulate collagen healing
- Independent ambulation without crutches
- Continue general conditioning
Plan:
- Continue phase I exercises
- Continue patellar mobilization and ROM activities
- Continue hamstring and calf stretching
- Standing ½ squat
- Joint and soft tissue mobilization as needed
- Isotonic hamstring NK table, Leg press
- Continue closed chain, balance and proprioceptive activities
- Continue EMS as needed for muscle re-ed and edema
- Step-ups (controlled – forward and side)
- *McConnell tapping as necessary)
- May begin swimming with modified kick (No “whip kick” or “egg beater kick”)
- General conditioning
Phase III (12-16 weeks)
Goals:
- Full ROM
- Continue all goals from Phase II
- Plan
- Continue phase II exercises and progress as tolerated
- Step-Up – side and down
- Increase proprioceptive training (sport cord, body blade, plyoballs)
- Treadmill as tolerated
- Continue Stairmaster
- ½ wall sits as tolerated
Plan (16-20 weeks)
- Light jogging on trampoline
- ¼ to 1/2 squats (painfree)
- Progress with closed chain activity
- Isotonic terminal knee extension (30-0°)
Phase IV (20-36 weeks)
Goals:
- Development of strength, power and endurance
- Begin to prepare for return to recreational activity
- Begin sport specific training
Plan:
- Continue Phase III exercise and conditioning activities
- Continue strength training
- Initiate running program
- Initiate agility drills
- Sport specific training and drills
- Isokinetic evaluation
Sig:
PT twice weekly x 6 weeks
Advance to FWB as Quad control allows
**TTWB x 6 wks if Meniscus Repair
Please forward a progress report via fax or e-mail at least one day prior to the next MD visit or give to the patient to hand deliver.